Displaying 1 - 4 of 4
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 72017 METALYSE 50MG INJ (BOE/STO) TENECTEPLASE 50MG VIAL BQ 2,535.76 50MG 0 2022-04-01 2024-03-31 0
41 72017 METALYSE 50MG INJ (BOE) TENECTEPLASE (BQ) 50MG VIAL BQ 2872.9966 50MG 0 2024-04-01 2026-03-31 0
42 72017 METALYSE 50MG INJ (BOE) TENECTEPLASE 50MG VIAL BQ 2,873.00 50MG 0 2026-04-01 No No 0
42 7201N ELAXIM 50MG INJ (EMC) TENECTEPLASE 50MG VIAL BQ 1,902.83 50MG 0 2026-04-01 No No 0